:''This page is about the condition called edema. For the rock band, see
Adema.''
'Edema' (
American English), 'oedema' or 'œdema' (
British English), formerly known as 'dropsy' or 'hydropsy', is the increase of
interstitial fluid in any organ — swelling. Generally, the amount of interstitial fluid is in the balance of
homeostasis. Increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.
Generation of
interstitial fluid is regulated by the
Starling equation of tissue fluid which states that it depends on the balance of
osmotic pressure and of
hydrostatic pressure which act in opposite directions across the
semipermeable capillary walls. Consequently, anything that increases oncotic pressure outside blood vessels (for example
inflammation), or reduces oncotic pressure in the blood (states of low
plasma osmolality, for example
cirrhosis) will cause edema. Increased
hydrostatic pressure inside the blood vessel (for example in
heart failure) will have the same effect. If the permeability of the capillary walls increases, more fluid will tend to escape out of the capillary, as can happen when there is
inflammation.
Abnormal removal of interstitial fluid is caused by obstruction of the
lymphatic system, for example due to pressure from a
cancer or enlarged
lymph nodes, destruction of lymph vessels by
radiotherapy, or infiltration of the lymphatics by infection such as
elephantiasis.
Peripheral edema
''Edema'' without a modifier usually refers to ''peripheral'' or ''dependent edema'', the accumulation of
fluid in the parts of the body that are most affected by
gravity. In ambulatory people these are the
legs, although in those who are bedbound the first manifestation may be
sacral edema. If severe enough, peripheral edema may progress to involve the abdominal or even thoracic wall (this may be referred to as ''generalized'' edema or
anasarca). In particular edema states (e.g.
nephrotic syndrome, see below), ''periorbital edema'' (around the eyes) may be present.
Some phenomena may distinguish different causes of peripheral edema. Most peripheral edema is ''pitting edema'' - pressing down will lead to a shift in the interstitial fluid and the formation of a small pit that resolves over seconds. Non-pitting edema may reflect ''
lymphedema'', a form of edema that develops when the
lymph vessels are obstructed, or ''
myxedema'', which occurs in hypothyroidism.
Causes of peripheral edema are:
★ high
hydrostatic pressure of the
veins, leading to poor reabsorption of fluid
★
★ venous obstruction, e.g.
deep vein thrombosis (typically one-sided)
★
★
congestive heart failure
★
★
varicose veins
★
★ asymmetric compression of thigh and leg (e.g., knee pads, tight jeans)
★ low
oncotic pressure
★
★
cirrhosis
★
★
malnutrition
★
★
nephrotic syndrome (renal protein loss)
★
★
epidemic dropsy
★ obstruction of
lymph drainage
★
★ infection
★
★
cancer
★
★ fibrosis after surgery
★
★
filariasis
★
inflammation (active secretion of fluid into the interstitial space due to increased membrane permeability by inflammatory mediators):
★
★
allergic conditions (e.g.
angioedema)
★
★ any other form of inflammation (''tumor'' - or swelling - is one of the main characteristics of inflammation)
Organ-specific edema
Edema of specific organs (
cerebral edema,
pulmonary edema,
macular edema) may also occur, each with different specific causes to peripheral edema, but all based on the same principles.
Ascites is effectively edema within the
peritoneal cavity, as
pleural effusions are effectively edema in the
pleural cavity. Causes of edema which are generalized to the whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause peripheral edema, pulmonary edema, pleural effusions and ascites.
Common and usually harmless appearances of cutaneous edema are observed with
mosquito bites and skin contact with certain plants (
urticaria).
Edema may be found in the eyes after corrective surgery.
Edema in plants
Edema in plants is the extended swelling in plant organs caused primarily by an excessive accumulation of water.
References
★
Peripheral oedema, Cho S, Atwood J, , , Am J Med, 2002
External links
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Medline Encyclopedia - Swelling